STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2009008828 v. Return Receipt Requested: 7009 0080 0000 0586 3439 OLIVINNE’S IN-HOME CARE, INC, d/b/a OLIVINNE’S IN-HOME CARE, INC., ‘ / Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Olivinne’s In-Home Care, Inc., d/b/a Olivinne’s In-Home Care, Inc. (hereinafter “Olivinne’s In-Home Care, Inc.”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2010), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $3,000.00 pursuant to Section 429.19(2), Florida Statutes (2010), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and “120.57, Florida Statutes, and 28-106, Florida \ Administrative Code. Filed December 15, 2010 10:35 AM Division of Administrative Hearings 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. . AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 429, Part I, Florida Statutes (2010), and Chapter 58A-5, Florida Administrative Code. 5. Olivinne’s In-Home Care, Inc. operates a 7-bed assisted living facility located at 3153 NW 114° Avenue, Coral Springs, Florida 33065. Olivinne’s In-Home Care, Inc. is licensed as an assisted living facility license number AL8918, with an expiration date of April 17, 2011. Olivinne’s In-Home Care, Inc. was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I OLIVINNE’S IN-HOME CARE, INC. FAILED TO DETERMINE THAT ALL RESIDENTS WERE APPROPRIATE FOR ADMISSION Rule 58A-5.0181(1) (k)2, Florida Administrative Code ‘ (ADMISSION CRITERIA STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the complaint investigation conducted on 7/06/09 and based on record review and interview with the - Administrator on the day of the survey, at approximately 2 PM, the Administrator failed to determine that all residents admitted to the facility were appropriate for admission and not require assistance with tube feedings for one of three resident records reviewed (resident #2). 8. During the record review and interview with the Administrator of the facility on 7/06/09, it was revealed that resident #2 was admitted to the facility on 4/10/09 from a skilled rehabilitation facility with a feeding tube. The resident was not able to provide self care for this feeding tube and required nursing care. This information was clearly stated on the discharge papers. The Administrator stated during the interview that she did not consider the medical information that came with the resident prior to or at the time of admission to the facility. The resident was an inappropriate admission to the facility, as the resident was not able to self-maintain, the tube feedings. The Administrator failed to provide or arrange for the required services to meet the needs of resident #2. 9. Resident #2 was admitted to the facility with a Percutaneous Endoscopic Gastrostomy (PEG) feeding tube. The discharge orders upon admission to the facility stated the \ resident was to be given Jevity one can four times a day. There were no care orders for the maintenance of the feeding tube. The Administrator stated the resident was fed regular food and given his/her tube feedings by the resident's family member. The facility maintained no records of any provision of these tube feedings. The facility accepted and admitted this resident without the ability to meet their needs. 10. Resident #2 was sent to the hospital on 4/23/09 complaining of pain. The resident was seen in the Emergency Room and diagnosis with malnutrition and eight pressure ulcers, including a Stage IV pressure ulcer to the sacral and buttocks areas. The resident was discharged on 4/23/09 as per the Administrator. 11. During an interview at approximately 2:00 PM, the Administrator acknowledged the findings. 12. Based on the foregoing, Olivinne’s In-Home Care, ‘Inc. violated 58A-5.0181(1) (k)2, Florida Administrative Code, a Class II deficiency, which carries, in this case, an assessed fine of $1,000.00. COUNT II OLIVINNE’ S IN-HOME CARE, INC. FAILED TO DETERMINE RESIDENTS ADMITTED WERE APPROPRIATE TO MET THE UNIFORM SAFETY STANDARDS FOR ASSISTED LIVING FACILITIES Rule 58A-5.0181(1) (n)1-3, Florida Administrative Code (ADMISSION CRITERIA STANDARDS) CLASS II VIOLATION 13. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 14. During the complaint investigation conducted on 7/06/09 and based on record review and interview with the Administrator on 7/6/09 approximately 12 PM, it was determined that the facility failed to determine that the residents admitted were appropriate for admission and met the uniform safety standards for assisted living facilities for one out of three resident records reviewed (resident #2). 15. During the record review and interview with the Administrator of the facility on 7/6/09, it was revealed that resident #2 was admitted on 4/10/09 from a skilled nursing rehabilitation facility with a Percutaneous. Endoscopic Gastrostomy (PEG) feeding tube. The discharge orders for this resident upon admission to the facility stated the resident was to be given Jevity, one can four times a day. This resident was not able to provide self care for this feeding tube and required nursing care. This information was clearly stated on the discharge papers. The Administrator stated during the interview she did review the medical information prior to or at the time of admission of resident #2, but admitted the resident. The resident was an inappropriate admission to the facility and the Administrator failed to provide or arrange for the required services to meet the care needs of resident #2. 16. During an interview at approximately 2:00 PM, the d Administrator acknowledged the findings. 17. Based on the foregoing, Olivinne’s In-Home Care, Inc. violated 58A-5.0181(1)(n)1-3, Florida Administrative Code, a Class II deficiency, which carries, in this case, an assessed fine of $1,000.00. COUNT III OLIVINNE’S IN-HOME CARE, INC. FAILED TO PROVIDE CARE AND SERVICES APPROPRIATE TO THE NEEDS OF RESIDENTS Rule 58A~-5.0182, Florida Administrative Code (RESIDENT CARE STANDARDS) CLASS II VIOLATION 18. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 19. During the complaint investigation conducted on 7/06/09 and based on record review and interview, it was determined that the facility failed to provide care and services appropriate to the needs of residents accepted for admission to the facility, for one (#2) of three sampled residents, as evidenced by admitting and retaining a resident who required skilled nursing services. 20. During the record review and interview with the Administrator of the facility on 7/6/09, it was revealed that resident #2 was admitted to the facility on 4/10/09 from a skilled rehabilitation facility with a feeding tube. The resident was not able to provide self care for this. feeding tube and required nursing care. This information was clearly stated on the discharge papers. The Administrator stated during the interview she did not consider the medical information that came with the resident prior to or at the time of admission to the facility. The resident was an inappropriate admission to the facility as the resident was not able to self maintains the tube feedings. The Administrator failed to provide or arrange for the required services to meet the needs of resident #2 with his/her feeding tube. 21. Resident #2 was admitted to the facility with a Percutaneous Endoscopic Gastrostomy (PEG) feeding tube. The discharge orders upon admission to the facility stated. the resident was to be given Jevity one can four times a day. There were no care orders for the maintenance of the feeding tube. The Administrator stated the resident was fed regular food, with the diagnosis of dysphagia, and given his/her tube feedings by the resident's family member. The facility accepted and admitted this resident without the ability to meet his/her needs and maintained no records of any assistance provided with his/her prescribed tube feedings. Resident #2 was admitted to the facility weighing 123 lbs per the resident's physician and facility weight record. This resident was admitted to the hospital, with a diagnosis of malnutrition, weighing only 109.5 lbs 10 days later. \ 22. Resident #2 was sent to the hospital on 4/23/09 complaining of pain. Upon admission to the hospital on 4/23/09, it was revealed that the resident, while at the facility had developed several decubitus pressure ulcers ranging from a Stage I to a Stage 4 on his/her coccyx. The Administrator did not provide the care needed for this resident to meet this resident's needs and within the 13 days of residency, permitted the resident to develop these ulcers and his/her medical condition to deteriorate. 23. During an interview at approximately 2:00 PM, the Administrator acknowledged the findings. 24. Based on the foregoing, Olivinne’s In-Home Care, Inc. violated 58A-5.0182, Florida Administrative Code, a ' Class II deficiency, which carries, in this case, an assessed fine of $1,000.00. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Counts I, II and III. B. Assess an administrative fine of $3,000.00 against Olivinne’s In-Home Care, Inc. on Counts I, II and III for three Class II violations. Cc. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2009). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 412-3630. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION ,OF TH# FACTS ALLEGED IN Assistant General Counsel Agency for Health Care Administration 8350 N. W. 52™ Terrace Suite 103 Miami, Florida 33166 Copies furnished to Field Office Manager Agency for Health Care Administration 5150 Linton Boulevard, Room 500 Delray Beach, Florida 33484 (U.S. Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy-of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Seymour Williams, Administrator, Olivinne’s In-Home Mare, ns Up. 144 avenue, Coral Springs, Florida 33065, on Hm oor9. Tria Lawton- obo HIS SECTION ON DELIVERY D flog EA poet bie CE hit _ : OD Addressee _ \by ( Printed Name) CG. Date.o wa) nee | SENDER: COMPLETE THIS SECTION m Complete items'1,.2,'and 3.:Also complete: iter 4 If Restricted Delivery 's. desired: 1 a Print your name and address on the reverse 1” so that we can return the dard to'you. ‘ | @ Attach this card to the back of the maliple ; or on the front. If space permits. 7. article Addressed to: 2. Article Number Val (Transtat trom'service_! ' PS Form 3811, February 2004 402595-02.N-1640 +

Docket for Case No: 10-010609

Orders for Case No: 10-010609